RAJ MOHAN PASPULATI1, KARIN HERMAN1, and AMIT GUPTA1
1RADIOLOGY, UNIVERSITY HOSPITALS, CASE WESTERN RESERVE UNIVERSITY, CLEVELAND, OH, United States
Synopsis
In
this exhibit we share our 3 year experience of sequential design PET-MR (Phillips
Ingenuity TF PET/MR) application in staging and follow up of gynecologic
cancers. Hybrid PET-MR imaging is a new evolving technique and has a
useful role in staging, treatment planning and follow up of gynecologic
cancers. Standardization of the imaging protocol and understanding its
limitations and pit falls is essential before considering regular clinical
application.Purpose:
1.Application of PET-MR in initial staging,
treatment planning and follow up of gynecologic cancers 2.Advantages and limitations of PET-MR
3.Work flow, technical challenges and pitfalls of
PET-MR
Outline of content:
FDG-PET CT and MRI are established imaging techniques for
initial staging and follow up of gynecological malignancies. MRI is used for
initial T- staging of cervical, vaginal and vulvar cancers and PET-CT for nodal
and distant metastases (NM staging). Integrated Hybrid PET-MR systems are in clinical
use for over 3 years for both oncologic and non-oncologic applications. In this
exhibit we share our 3 year experience of sequential design PET-MR (Phillips
Ingenuity TF PET/MR) application in staging and follow up of gynecologic
cancers. This included initial staging and follow up after external beam &
Brachytherapy of advanced cervical carcinoma ; staging and follow up of vulvar
and vaginal after surgery of Radiation treatment; Initial staging and follow up
after chemotherapy of advanced ovarian carcinoma; local recurrence of
surgically treated endometrial cancer and its treatment planning. Patient
compliance is an important factor in this hybrid imaging and MR scan timing has
to be restricted to selected useful sequences. The exhibit illustrates the
PET-MR work flow and optimal MRI sequences suitable for this complementary imaging
technique. Strengths and weaknesses of MRI and FDG-PET in TNM staging will be
discussed. Limitations of both imaging modalities in detection of lymph nodal and
lung metastases will be illustrated.
Summary:
Hybrid PET-MR imaging is a new evolving technique and has a
useful role in staging, treatment planning and follow up of gynecologic
cancers. Standardization of the imaging protocol and understanding its
limitations and pit falls is essential before considering regular clinical
application.
Acknowledgements
No acknowledgement found.References
• Nakamoto Y, Saga T, Fujii S.
Positron emission tomography application for gynecologic tumors. Int J Gynecol
Cancer. 2005;15:701–9.
•Basu S, Li G, Alavi A. PET and PET-CT imaging
of gynecological malignancies: Present role and future promise. Expert Rev
Anticancer Ther. 2009;9:75–96.
•Lin WC, Hung YC, Yeh LS, Kao CH, Yen RF, Shen
YY. Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to
detect para-aortic lymph nodal metastasis in advanced cervical cancer with
negative computed tomography findings. Gynecol Oncol. 2003;89:73–6.
•Belhocine T, Thille A, Fridman V,
Albert A, Seidel L, Nickers P, et al. Contribution of whole-body 18FDG PET
imaging in the management of cervical cancer. Gynecol Oncol. 2002;87:90–7.
•Grigsby PW, Siegel BA, Dehdashti
F, Mutch DG. Posttherapy surveillance monitoring of cervical cancer by FDG-PET.
Int J Radiat Oncol Biol Phys. 2003;55:907–13. [PubMed]
•Bristow RE, del Carmen MG, Pannu HK, Cohade C,
Zahurak ML, Fishman EK, et al. Clinically occult ovarian cancer: Patient
selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol.
2003;90:519–28.